My work in Uganda is related to understanding the determinants of the use of bednets. These insecticide-treated nets have the potential to dramatically improve the lives of pregnant women and their children. Mere ownership in a household has been correlated with a 20% decrease in mortality among children under 5 years of age.
Uganda and especially western Uganda, has a very high level of malaria. It is a significant burden on the health system and leads to lives lost and time away from work. Bednets are often too expensive for households and even when they own them, they don't always use them as they are meant to be used.
I spent multiple afternoons visiting households in rural villages trying to understand the barriers to bednet use. This usually involved trekking into the banana trees with a local health worker and showing up at households. The first thing they would always do is invite us in to their homes. No matter how poor, they always invited us in, asked us to sit and thanked us for coming.
In many of the households, the walls were made of crumbling mud caked onto wooden frames. The ground was packed dirt and there were only a few small (small) rooms. The bednets I saw typically took up the whole space of the bedroom. Challenges included keeping them clean, finding creative ways to mount them in such small spaces, and finding ways to put them up adequately over sleeping areas.
I spent a lot of time asking people about their perceptions of bednets and their understanding of why they are used. We also discussed local programs for bednet distribution and ways that the people thought these programs could be improved. Often I would talk with the village health worker after I'd left the houeshold to get the "real scoop" about that household's malaria behaviors. I heard about husbands who refuse to sleep under the nets for fear of reducing their sperm count. I heard about how nets make people too hot so they aren't used in the humid rainy season (the time they are most needed). I heard about bednets made into wedding veils for local celebrations.
There is much to learn about how this technology makes it way into the real lives of local people. And that is where I am focusing my work.
Paul J. Krezanoski, MD